Audiologists and Physician Referral for Vestibular Testing

Questions posed by students{{1}}[[1]]Really smart students[[1]] over the years

I have general questions in regards to establishing a balance clinic for private practice audiologists not associated with an ENT.  Does Medicare require referral for this test the same as audios, etc..and if someone called in off the street with dizziness complaints (other than Medicare insurers) can we do ENG testing without any kind of physician referral. If so, what is the climate of the physicians when they receive this report? Would they think audiologists are haphazardly doing ENGs or would they receptive.

My basic question is that I agree that most general physicians just prescribe Meclizine and send them on their way, but if the patient came to see the physician on the initial visit with an audiologists report in hand, do they view that as credible info?…..in other words, are we part of the loop as independent practitioners or would they view that as us overstepping our bounds???

Thank you,   D F

Dear DF:

Yes, Medicare does require a physician referral for all (including vestibular) testing billed by an Audiologist. Many commercial insurers do not require this, but that would have to be determined on a case by case basis. Our clinic policy is to accept referrals for vestibular examination by physician referral only, regardless of insurance provider. We have Audiology and ENT under the same roof, part of the same corporation, so we could take all patients (including Medicare and Medicaid) directly.  We choose not to do so for other reasons:

1. It is not unusual for us to see a patient that is dizzy secondary to non-otologic medical conditions or medication.
2. Occasionally, we will see a medical emergency ( such as a brain stem stroke) walk in the door.
3. A patient with a vague dizziness complaint of short duration (a few days) probably doesn’t need a vestibular evaluation.{{2}}[[2]]There is one obvious exception to the logic of my argument. Tune in next week for details.[[2]]

If you see a patient with a potentially significant medical problem, you need to have somewhere to send them ASAP. The ENT guys in our group don’t want to deal with non-otologic problems. For all these reasons, we think it is best for the patient to be screened first by the primary care physician.

As far as the climate for how a PCP would view their patient going to Audiology first, I suspect it varies by locale and individual. Our approach is to present our clinic as there to help, not replace or substitute the PCP from the process. We focus all of our marketing for vestibular services on the PCP through newsletters, continuing ed. programs, mailing articles of interest, etc. The PCP that understands what you do will be your best referral source. Also, by only accepting PCP referrals, you are acknowledging the value and showing respect for the PCP role.